Community Care Practice Research Articles

Community Care Strategies for Older Adults Facing Hardships: Insights from Central Thailand

The focus of the study is to analyze the community care approach for older adults facing hardships in the social and cultural context of the central region of Thailand. To obtain insightful information, a qualitative research study was performed using observation methods, in-depth interviews, focus group discussions, secondary data, and field notes. A group of 85 key informants consisting of local administrative organizations (LAO), public sector officers from health service units, community leaders, civil groups, older adults facing hardships, and family caregivers participated in the study. There are nine approaches employed in the community care practices for older adults facing hardships as follows: 1) providing social welfare; 2) preparing and using information; 3) developing a service system; 4) developing potential in caring for older adults; 5) adjusting the environment to ensure its contribution to the living conditions; 6) rules, regulations, agreements, and policies; 7) creating job opportunities; 8) building food security; and 9) building and strengthening community networks. Understanding in-depth information regarding the nature of older adults, community strategies, and community involvement assists nurses in health management and increasing skills and knowledge on providing care for older adults.

IJCM_72A: A study on newborn care practices and associated factors influencing their health in urban slums of Kurnool city, Andhra Pradesh.

Background: Neonate is essential time for child to grow. Worldwide, Neonatal mortality are estimated to be about 3 million due to insufficient care. In 2021, 2.3 million neonates have died in first four weeks of life, roughly 6400 neonatal deaths per day. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality. Newborn care practice interventions can prevent neonatal deaths. Understanding the community and traditional newborn care practices is necessary to implement effective programme for promotion of newborns health. Hence present study was done to describe selected newborn care practices in urban slums of Kurnool. Objectives: To assess Newborn-Care Practices and to determine the relationship between Newborn-Care Practices and selected socio-demographic variables. Methodology: A Community-based, Cross-sectional study was done among 220mothers who were residing in urban slums of Kurnool City, Data were collected between October 2023 to November 2023 using Semi-structured questionnaire by Simple Random sampling technique. IEC permission was obtained. Written informed consent was obtained from participants. Data were analyzed using SPSS-Version23. Results: Mothers who were practicing delayed-bathing were observed in the age group 18-24 years 135(61.36%)followed by 25-30 years 60(27.2%),the difference was statistically significant(x2=9.84)(p=0.043),Safe cord care practices were observed more among 18-24 years132(60%),it was found to be statistically significant(x2=23.5)(p=<0.001). Early initiation of breast feeding was more common among age group 18-24 years93(42.2%), it was found to be statistically significant(x2=6.51)(p=0.039). Conclusion: The practice of essential newborn care still needs to improve in Bareilly; There is strong need to implement community-based interventions to improve the newborn care practices & to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, Prelacteal feeding & discarding colostrum need through health workers.

The Observatoire en Ville des Plaies ExSudatives (VIPES) Study: Insight Into the Patient Characteristics, Epidemiology, Previous Management, and Features of Wounds Treated in the French Community Setting

Background. Wounds that become complex and hard-to-heal are a challenge for all health care systems. Identifying and understanding the nature of these wounds is necessary to allow appropriate intervention. Objective. To present the epidemiological outcomes of the VIPES study. Materials and Methods. The prospective, observational VIPES study aimed to describe the use and investigate the performance of 2 wound dressings—a silicone foam and a gelling fiber—in the management of chronic and acute wounds in a community setting in France. Results. Of 407 patients recorded, 285 were included in the analysis. The 184 chronic wounds included ulcers (venous/arterial/mixed, diabetic foot, and pressure) and malignant wounds. The 101 acute wounds included surgical and traumatic wounds. Of all wounds, 98.2% were exuding and 77.9% showed exudate pooling. Unhealthy wound edges and periwound skin were reported in 57.2% and 35.4% of wounds, respectively. Of all wounds, 78.6% were in treatment failure (poor exudate management or stagnant wound). The silicone foam dressing (n = 86) and the gelling fiber (n = 199) were generally used in wounds with low or moderate exudation, or moderate or high exudation, respectively. Conclusions. The VIPES study highlights that wounds can be complex and that community care practices in France warrant improvement. Practical and up-to-date wound management recommendations are needed.

A Scoping Review of Australian Literature on People Who Use MDMA and Their Harm Reduction Practices

Background: Discourses around MDMA are often predominantly concerned with identifying risk and characterizing harm. Reluctance from Australian governments to reform drug policy and implement harm reduction services has created a policy and service gap, and it is therefore pertinent to consider how people who use MDMA mediate potential harms, and how this knowledge can inform approaches to drug use and policy reform. This community-led scoping review aimed to identify Australian literature on the practices of harm reduction strategies by people who use MDMA. Methods: Seven topic-specific and multidisciplinary databases were searched in February 2023 in line with conventional scoping review methodology. Eligible articles were published from 2002 onwards, reported on the voices of people who use MDMA as primary evidence within the context of Australia, and included at least one strategy to reduce harm. Data were analyzed by drawing on conventional content analysis and thematic analysis frameworks. Results: Twenty-three peer-reviewed and gray literature sources were included. Five key themes were identified on how people mediate harms and enhance the pleasurable aspects of MDMA use: drug consumption practices, planning and preparation, testing drugs, accessing health services, and community care practices. Conclusion: The results suggest that people who use MDMA take care to identify and reduce unwanted harms. The way people who use MDMA make decisions around drugs is mediated by peer groups and online technologies, as well as broader social and cultural contexts of drug use and drug prohibition. More qualitative, participatory, and action research projects are recommended to accurately reflect the views and needs of people who use MDMA and meaningfully shape service reform.

OR32-03 mRNA Expression Based Tumor Behavior Prediction Models In Thyroid Nodules

Abstract Disclosure: A. Golding: None. G. Correa: None. E. Valenzuela Sheker: None. R. Jiang: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. Y. Hao: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. Y. Liu: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. J. Huang: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. J.P. Klopper: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. R.T. Kloos: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. G.C. Kennedy: Employee; Self; Veracyte, Inc. Stock Owner; Self; Veracyte, Inc. D. Bimston: None. The 2015 ATA thyroid cancer risk stratification system is driven primarily by the extent of vascular and extrathyroidal extension, as well as lymph node metastases. The objectives of this study were to evaluate the prevalence of invasion and lymph node metastases in a cohort enriched with thyroid malignancies and provide a risk signature with a high negative predictive value ruling out these tumor features. Histopathology reports from Afirma Genomic Sequencing Classifier (GSC) algorithm training and from thyroid cancer patients managed at an integrative endocrine surgery community care practice (total 697 and ∼50% from each) were reviewed for invasion and metastases. An integer from 0-3 was assigned based on the extent of invasion (ranging from none to extensive extra-thyroidal) or extent of lymph node metastases (ranging from none to lateral node metastases). To develop predictive signatures for invasion/metastases, over 400 literature-derived expression-based signatures were evaluated; they cover a broad spectrum of molecular processes, including cancer hallmarks such as endothelial to mesenchymal transition, tumor microenvironment, immune-oncology, metabolism, and treatment sensitivity. Further, acknowledging that multiple complex molecular processes are associated with invasion/metastases, over 200 machine-learning (ML) models were trained within the repeated and nested cross-validation (CV) framework. They utilized these literature-derived signatures as well as differentially expressed genes between high and low risk of invasion/metastases as the basic building blocks. The application of top performing signatures among Bethesda (B) V/VI nodules as well as indeterminate thyroid nodules (ITN - BIII/IV) that are GSC-suspicious, showed that 40-50% of these lesions were marked as low risk for invasion/metastases. With a starting prevalence of 10.0% of high-level invasion (scored 2 or 3), 41.3% of the cohort is ruled out for clinically relevant invasion with a negative predictive value (NPV) of 97.6%. With a starting prevalence of 11.3% of high-level metastases (scored 2 or 3), 49.8% of the cohort is ruled out for clinically relevant metastases with an NPV of 98.6%. The rule-out capability represents more than 4-fold or 7-fold reduction in high-level invasion/metastases from the baseline prevalence, respectively. Expression-based signatures that confidently rule out tumor invasion and metastasis may help personalize the surgical approach for individuals. This may reduce excess surgery and overtreatment, optimizing the initial response to therapy and decreasing the rates of surgical complications and post-operative hypothyroidism. Presentation: Sunday, June 18, 2023

3 Implementation of Family-based Treatment Principles in the Primary Care Management of Paediatric Anorexia Nervosa

Abstract Background Anorexia nervosa (AN) is a complex illness frequently beginning in adolescence and often associated with significant medical complications. In Canada, youth with AN typically first present to a primary care provider. Currently, the standard of care for paediatric restrictive eating disorders is Family Based Treatment (FBT). However, access to this modality remains limited. Numerous principles of FBT, including behavioural approaches to treatment, could be applied in a community setting. However, little is known regarding the awareness and uptake of FBT principles by primary care providers. Objectives To identify the extent to which FBT principles are understood and implemented by community providers (family physicians and community paediatricians) in treating paediatric patients with anorexia nervosa. Design/Methods We undertook a cross-sectional survey among family physicians and community paediatricians from 5 paediatric, urban, community clinics in Montreal, Quebec. Participants completed a standardized, self-administered electronic questionnaire to characterize their knowledge and degree of implementation of FBT principles in the treatment of adolescent AN. All practicing physicians who evaluated paediatric patients (age 5-18 years) were recruited to participate. Physicians were excluded if they self-reported spending less than 50% of their clinical practice in community care or were not involved in the assessment of eating disorder patients. Chi-square testing was used to compare frequency data between family physicians and community paediatricians. Results Survey response rate was 65% (n=36/55; 16/20 family physicians and 16/32 paediatricians, 4/55 other). Half of respondents had been in practice for over 10 years. Overall, 56% of respondents reported referring all their paediatric AN patients to tertiary services. Less than half of respondents (31.3%) reported following these patients weekly or biweekly once a referral was sent. Frequency of follow up did not vary for paediatricians and family physicians (37.5% vs. 25% p=0.45). Across both groups, 50% reported good knowledge of FBT principles, yet 47% reported using or expecting a nutritionist to use strict meal plans during treatment. There was no significant difference between family physicians and paediatricians in their reported awareness of FBT principles (43.8% vs. 56.3% p=0.48), and knowledge of behavioural management techniques in the treatment of paediatric AN (31.3% vs. 37.5% p=0.71). Overall, only a small percentage felt comfortable in applying FBT principles in the community (12.5% of family physicians vs. 6.3% of paediatricians, p=0.54) and 63% felt unaware of existing resources to assist physicians in implementing the tenets of FBT in a community practice. Conclusion Survey results suggest poor awareness and implementation of FBT principles in the community medical management of adolescent AN. FBT-specific education likely represents an important intervention to optimize physician comfort and improve the early delivery of appropriate care for adolescents with eating disorders.

Communities of Care: The Social Ethics of Victorian Fiction; The Science of Character: Human Objecthood and the Ends of Victorian Realism

Communities of Care: The Social Ethics of Victorian Fiction; The Science of Character: Human Objecthood and the Ends of Victorian Realism

Azamba publics: containment, care and curating in the “expanded private sphere”

ABSTRACT The lack of space, movement and even breath afforded to many communities cuts across seemingly mobile life trajectories, constraining and constricting even (and often especially) the movement of people across and within transnational borders. How do arts organisations and projects explicitly work against the violence of these forms of constraint? Where liberal models of the public sphere have underpinned many ideas of art in public space—particularly those based in the notions of appearance and the “general” public—it is from situated praxes originating from what Stahl and Stoecker have described as the “expanded private sphere” that poignant lessons can be learned of a community and curatorial practice dedicated to solidarity and support. In this paper, we elaborate a notion of art in public that refuses a division from the “private”, without straying unproblematically into the terrain of the personal or exploitative economies of care. We draw from our collaborative experiences in using creative strategies for countering the narrative containment of refugee groups in the face of UK media racism through the project Conflict, Memory, Displacement as well as the limitations we encountered. Using the concept of Azamba—a Malawan practice of community care and midwifery recently adopted by the women’s group Global Sistaz United in Nottingham, UK—we further elaborate how practices and narrations of care and community support might reconfigure our relation to ideas of art, curating and publics.

Construction of a Physical and Medical Care Integrated Model for the Elderly in the Community Based on Artificial Intelligence and Machine Learning.

With the increasingly serious population aging, economic system transformation, and social transformation, the elderly have an increasingly strong demand for the elderly care service industry, but the development of China's elderly care service industry started late, and there are still many problems. For how to build a better elderly care service model, under the current situation of shortage of elderly care resources, community elderly care may become a solution. By analyzing the status quo, existing problems and development trends of home-based care services in Hangzhou's community, and learning from foreign experience, it explores the establishment of a “integrated physical, medical, and nursing care” community health management model for the elderly and provides a perfect solution for the development of Hangzhou's community elderly care services countermeasures and suggestions for mode operation. Based on the evaluation, problem analysis, and empirical research on the current situation of home care services in Hangzhou communities, this paper draws on relatively mature community care practices, proposes to build a community elderly health management model that combines medical care and care, and improves and innovates the overall design and medical care of the elderly service model measures for the health management of the elderly in the integrated community. The experimental results of this study show that, according to the demand for elderly care services, elderly people in need of care account for 86.6%, 79.5%, and 68.4% of the elderly population, especially in the areas of medical care, life care, and housekeeping services.

Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study.

BackgroundLow birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant’s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity.ObjectiveWe employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan.MethodsWe conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions.ResultsNewborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies.ConclusionsKMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice.

¿Nuevas formas de sociabilidad y politicidad en torno a los cuidados? Los movimientos sociales desde la perspectiva de los cuidados

This article explores community care as part of social movements’ territorial organization and, in addition, proposes to present useful analytical keys and dimensions for its study. The subjective and practical experience of women as leading roles plays here a central part, and makes it possible to develop many assumptions about the forms of political bonds and sociability concerning community care. The results of the study are based on the analysis of in-depth interviews with female caregivers who participate in territorially-based social movements. In addition, we also consider other experiences analyzed by the literature in order to trace the place given to community care practices and care relationships.

Process evaluation of a programme to empower community nurse leadership

BackgroundThe Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL.MethodsA mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (n = 7), focus groups with team members (n = 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (N = 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis.ResultsNitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses.ConclusionsNitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.

Budesonide Oral Suspension Improves Outcomes in Patients With Eosinophilic Esophagitis: Results From a Phase 3 Trial

Background & AimsEosinophilic esophagitis (EoE) is a chronic, immune-mediated disease for which there is currently no pharmacologic therapy approved by the U.S. Food and Drug Administration. MethodsIn this double-blind, placebo-controlled, phase 3 trial, patients 11–55 years of age with EoE and dysphagia were randomized 2:1 to receive budesonide oral suspension (BOS) 2.0 mg twice daily or placebo for 12 weeks at academic or community care practices. Co-primary endpoints were the proportion of stringent histologic responders (≤6 eosinophils/high-power field) or dysphagia symptom responders (≥30% reduction in Dysphagia Symptom Questionnaire [DSQ] score) over 12 weeks. Changes in DSQ score (key secondary endpoint) and EoE Endoscopic Reference Score (EREFS) (secondary endpoint) from baseline to week 12, and safety parameters were examined. ResultsOverall, 318 patients (BOS, n = 213; placebo, n = 105) were randomized and received ≥1 dose of study treatment. More BOS-treated than placebo-treated patients achieved a stringent histologic response (53.5% vs 1.0%; Δ53% [95% confidence interval (CI), 43.8%–59.5%]; P < .001) or symptom response (52.6% vs 39.1%; Δ13% [95% CI, 1.6%–24.3%]; P = .024) over 12 weeks. BOS-treated patients also had greater improvements in least-squares mean DSQ scores and EREFS over 12 weeks than placebo-treated patients: DSQ, –13.0 (SEM 1.2) vs –9.1 (SEM 1.5) (Δ–3.9 [95% CI, –7.1 to –0.8]; P = .015); EREFS, –4.0 (SEM 0.3) vs –2.2 (SEM 0.4) (Δ–1.8 [95% CI, –2.6 to –1.1]; P < .001). BOS was well tolerated; most adverse events were mild or moderate in severity. ConclusionsIn patients with EoE, BOS 2.0 mg twice daily was superior to placebo in improving histologic, symptomatic, and endoscopic outcomes over 12 weeks. BOS 2.0 mg twice daily was well tolerated. ClinicalTrials.gov number: NCT02605837.

Measuring characteristics of individuals: An updated systematic review of instruments' psychometric properties.

Identification of psychometrically strong implementation measures could (1) advance researchers' understanding of how individual characteristics impact implementation processes and outcomes, and (2) promote the success of real-world implementation efforts. The current study advances the work that our team published in 2015 by providing an updated and enhanced systematic review that identifies and evaluates the psychometric properties of implementation measures that assess individual characteristics. A full description of our systematic review methodology, which included three phases, is described in a previously published protocol paper. Phase I focused on data collection and involved search string generation, title and abstract screening, full-text review, construct assignment, and measure forward searches. During Phase II, we completed data extraction (i.e., coding psychometric information). Phase III involved data analysis, where two trained specialists independently rated each measurement tool using our psychometric rating criteria. Our team identified 124 measures of individual characteristics used in mental or behavioral health research, and 123 of those measures were deemed suitable for rating using Psychometric and Pragmatic Evidence Rating Scale. We identified measures of knowledge and beliefs about the intervention (n = 76), self-efficacy (n = 24), individual stage of change (n = 2), individual identification with organization (n = 7), and other personal attributes (n = 15). While psychometric information was unavailable and/or unreported for many measures, information about internal consistency and norms were the most commonly identified psychometric data across all individual characteristics' constructs. Ratings for all psychometric properties predominantly ranged from "poor" to "good." The majority of research that develops, uses, or examines implementation measures that evaluate individual characteristics does not include the psychometric properties of those measures. The development and use of psychometric reporting standards could advance the use of valid and reliable tools within implementation research and practice, thereby enhancing the successful implementation and sustainment of evidence-based practice in community care. Measurement is the foundation for advancing practice in health care and other industries. In the field of implementation science, the state of measurement is only recently being targeted as an area for improvement, given that high-quality measures need to be identified and utilized in implementation work to avoid developing another research to practice gap. For the current study, we utilized the Consolidated Framework for Implementation Research to identify measures related to individual characteristics' constructs, such as knowledge and beliefs about the intervention, self-efficacy, individual identification with the organization, individual stage of change, and other personal attributes. Our review showed that many measures exist for certain constructs (e.g., measures related to assessing providers' attitudes and perceptions about evidence-based practice interventions), while others have very few (e.g., an individual's stage of change). Also, we rated measures for their psychometric strength utilizing an anchored rating system and found that most measures assessing individual characteristics are in need of more research to establish their evidence of quality. It was also clear from our results that frequency of use/citations does not equate to high quality, psychometric strength. Ultimately, the state of the literature has demonstrated that assessing individual characteristics of implementation stakeholders is an area of strong interest in implementation work. It will be important for future research to focus on clearly delineating the psychometric properties of existing measures for saturated constructs, while for the others the emphasis should be on developing new, high-quality measures and make these available to stakeholders.

Navigating Turbulent Waters: Leading Home and Community Care Practice Change during the COVID-19 Pandemic

This case study outlines the journey of a home-care organization to support practice change during the COVID-19 crisis. The leadership attributes and organizational structures and processes required for a nimble knowledge-to-action response are explored in relation to client screening, personal protective equipment and development of virtual care. A home and community practice lens was often not evident in the literature or guidance documents. This added complexity to the process of rapidly evaluating evidence and guidance across two provinces and issuing practice direction to a widely dispersed and mobile workforce. A cross-functional clinical response team has been invaluable in the organization's pandemic response.

Implications of a US study on infection prevention and control in community settings in the UK.

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK.

Case study of toddlers stunting care practices in coastal communities

This study aimed to analyze the practice of nurturing stunting toddlers in the coastal community of Balang Lompo, Pangkep Regency. The study was conducted in the Balang Lompo Island, Pangkep Regency. This research design was qualitative research with a case study approach with in-depth interview techniques and uninvolved observation. The research subjects consisted of 12 key informants who had children aged 1-3 years and 6 supporting informants. The data were analyzed using content analysis. The results of the analysis showed the feeding of the child, the time of administration, the place of feeding, the rules of feeding, the frequency of eating fish, the role of family members, the atmosphere of stunting toddler feeding were still not optimal. It was concluded that the practice of child nutrition care on the Balang Lompo Island coast was still less than optimal due to low food access due to lack of transportation facilities on the Balang Lompo Island coastline, economic inequality, poor eating behavior and habits in the community, low knowledge and also low community participation at the Posyandu. Stunting childcare practices on Coastal Island of Balang Lompo are less than optimal.

Newborn Care Practices in Rural Communities of Nawalparasi District, Nepal

Most of the new born deaths in the developing countries occur due to lack of access to care, as majority of the deliveries occur at home. Even deliveries conducted in health facilities are prone to suffering from traditional care practice after discharge from health facilities. Most of these deaths could be avoided with changes in antenatal, delivery and newborn care practices. This study was conducted to explore the newborn care practices related to cord care, thermal care and breast feeding in rural setting and to identify socio-demographic, antenatal and delivery care factors associated with these practices. A cross sectional study in rural setting of Nawalparasi district included 296 women who had delivered live baby at home or discharged within 24 hours of delivery from hospital proceeding four months of data collection. Chi squire test was applied to compare sociodemographic, antenatal and delivery care factors associated with cord care, thermal care and breast feeding practices. Of the total 296 mother interviewed, only 65.54% have completed ANC visit at least 4 times and 29.05% have received counselling on newborn care during pregnancy. More than half deliveries (53.38%) were home deliveries and Clean Home Delivery Kit was used only one third (39.91%) of these deliveries. Of the three selected newborn care practices, clean cord keeping practice was found in only one fourth (25.70%) of deliveries. However early initiation of breast feeding and delayed bathing practice was found in about half of the deliveries (51.35% and 58.45% respectively). There is strong need to implement the community-based interventions to improve the new born care practices in community level and to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, prelacteal feeding and discarding colostrum need through the community level health workers and volunteers.&#x0D; Key words: Newborn care, Safe cord care, Early breast feeding, Thermal care, Delayed bathing.

Functional limitations recognised by adults with amblyopia and strabismus in daily life: a qualitative exploration.

Patients' perceptions about the functional impact of amblyopia and strabismus in daily life have not been explored extensively. Therefore, this study aimed to explore the lived experiences of adults with these conditions and understand the functional limitations they face in their day-to-day life. A qualitative study design was adopted. Participants over 18years of age, with a primary diagnosis of amblyopia (with or without strabismus) were recruited from the community and various eye care practices in South Australia and Victoria, Australia. Participants took part in either focus group discussions or individual interviews and described the functional limitations they experienced in their daily life due to their eye condition. These sessions were audio recorded, transcribed verbatim, coded inductively, and analysed iteratively to form emergent themes. Thirty-seven adult participants took part in the study: 23 (62%) had strabismic amblyopia; 5 (14%) anisometropic amblyopia;, 7 (19%) combined-mechanism amblyopia; and 2 (5%) deprivational amblyopia. Their median age was 54years (range: 21-82years) and 19 (51%) were female. Participants reported several challenges in performing everyday tasks such as driving (e.g. judging distances, changing lanes), reading (e.g. fine print, reading for prolonged time) and sports (e.g. catching a ball). They also articulated trouble in navigating safely (e.g. using stairs, bumping into objects), performing work-tasks (e.g. taking longer than peers to complete tasks) and other routine tasks (e.g. chopping vegetables with care). Several functional limitations were encountered by adults living with amblyopia and strabismus. Participants recognised these limitations in their normal day-to-day life and related the challenges they faced to symptoms associated with their eye condition. By presenting rich in-depth qualitative data, the paper demonstrates qualitative evidence of the functional impacts associated with amblyopia and strabismus.

Quality and Safety in Aged Care Virtual Issue: What Australian research published in the Australasian Journal on Ageing tells us

To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions. Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality. Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care. It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.